Efficacy of Laparoscopic Mesh-Augmented Hiatoplasty in GERD and Symptomatic Hiatal Hernia. Study Using Combined Impedance-pH Monitoring

Abstract

BackgroundLaparoscopic fundoplication is the standard antireflux procedure. However, side effects such as gas bloating indicate that the procedure is not unproblematic. Laparoscopic mesh-augmented hiatoplasty (LMAH) might be an alternative operation aimed at restoring the intra-abdominal part of the esophagus and reducing the size of the diaphragmatic hiatus. AimThe aim of this study was to prospectively evaluate gastroesophageal reflux disease symptoms and gastroesophageal reflux before and after LMAH using 24 h impedance-pH monitoring (MII-pH). Materials and MethodsTwenty patients underwent MII-pH monitoring pre- and 3 months post-LMAH. Symptoms were assessed using the Gastrointestinal Symptom Rating Scale questionnaire. ResultsLMAH reduced the mean (SD) reflux syndrome score [pre-op 4.5 (1.7) vs post-op 1.4 (0.9); p < 0.001], median (25th–75th percentile) distal %time pH < 4 [4.9 (3.4–10.3) vs 1.0 (0.3–2.5) %; p = 0.001) and total number of liquid reflux episodes [27.5 (17.5–38.3) vs 18 (7.3–29.3); p < 0.05] without changing the number of gas reflux episodes [12 (6–34.3) vs 13.5 (6–20); p = 0.346). All patients reported no limitation of their ability to belch. ConclusionLMAH significantly reduces reflux symptoms and esophageal acid exposure without interfering with the ability to vent gas from the stomach documented by an unchanged number of gas reflux episodes before and after LMAH.